Introduction
Obesity is a major health burden, with significant morbidity and mortality. Gastric tube twisting is an early uncommon serious complication. We aimed to compare laparoscopic sleeve gastrectomy (LSG) with or without minimal fixation to overcome such a complication.
Patients and methods
In our prospective cohort study, we reviewed medical records of patients undergoing LSG alone or LSG with minimal fixation. Patients with preoperative gastroesophageal reflux disease (GERD) were excluded. Patients were then followed postoperatively for gastric twist, leakage, or hemorrhage and then later for GERD, using upper gastrointestinal tract endoscopy and esophageal manometry. Missing patients were phone called and asked to attend the next day for follow-up.
Results
A total of 190 patients were included: 90 patients had LSG only, and 100 patients had LSG with minimal fixation. A significant difference was detected regarding operative time, with LSG with minimal fixation having a longer duration (=0.0001). Patients who had LSG with minimal fixation had less postoperative twist, leak, and de novo GERD compared with LSG only, yet no statistically significant difference was detected. Both surgeries had comparable BMI loss at 36 months of follow-up.
Conclusion
Our study showed that patients who had LSG with minimal fixation had less postoperative complications than patients with LS only, yet no statistically significant difference was detected. Several techniques, including distal fixation and minimal fixation, have been proposed to overcome such complications. Studies comparing these techniques are needed.